Daniel R. Hoffman, Ph.D.

President, Pharmaceutical Business Research Associates

The 19th century European Left often claimed that anti-semitism was "the socialism of fools." More recently a range of pundits have labeled the Tea Party in this country as the Populism of fools. Yet the issue of healthcare has made fools of both Democrats and Republicans.

Following the November 2 election, recognition has grown that the Obama White House made a colossal blunder by pushing healthcare reform as its major issue during the worst recession in 70 years. Unemployment and economic insecurity impose a constant anxiety, while healthcare, for those other than the sick and the uninsured, come and go as sources of worry. All the surveys have shown that joblessness and the economy provide the number one issue by a wide margin for a majority of Americans, while healthcare tops the list for fewer than 10%. In contrast to the economy's immediate problems (mortgage payments, tuition, utility bills), healthcare's increasing costs and narrowing availability advance slowly each year, so that evidence of substantial worsening requires a retrospective, decade-by-decade comparison.

Beyond the immediate versus the long-term anxiety factor, two other fundamentals of American political life made healthcare a loser for Obama. The first is that prospective, government planning, involving large issues, rarely occurs in this country. The founding fathers wanted government to remain a residual rather than a proactive force, and succeeding generations have supported that approach. That means things must first crash and burn in specific sectors of social life before the government can step in and effectively address the matter. For a majority of Americans, healthcare has not yet crashed and burned. In early 2005, Matthew Holt of The Health Care Blog examined polling data and concluded that it would take several, presidential election cycles for a sufficient number of Americans to feel that healthcare has eroded enough for them to want a government fix.

Then there is the fact that the Republicans did their job as smart politicians by crafting distorting slogans, half-truths and bumper-sticker lies (e.g., death panels, government healthcare takeover) while Obama and the Democrats stood mute or responded with tongue-tied gobble. Obama thought policy would provide an effective answer to forceful messages but, except in rare circumstances, the fact remains that politics will beat policy almost every time.

Now that the Republicans will drive the legislative agenda, they intend to use healthcare as a cat-of-nine-tails for whipping Obama. Their push to repeal the legislation enacted early this year will come to little, but that's beside the point because, win or lose, the effort provides them with a useful rallying cry. Beyond using healthcare as an organizing tool, Republican positions consist of their reflexive approach to all social and economic issues -- cut taxes and stifle the government so the "free market" can solve everything.

If this was the 18th century, where the economy consisted of small landholders and local manufacturers, that soothing myth might have some practical value. Most industries today, by contrast, have devolved into oligopolies and those behemoth companies abhor a free market. Last week, for example, pharma reporter Jim Edwards wrote of a situation where manufacturers of hospital supplies were charging state Medicaid programs $928 for each bag of saline solution or sugar water. That sort of situation emerges regularly because federal law, kneeling before the myth of "unshackling the free market," prohibits Medicare and Medicaid from negotiating prices with manufacturers the way the Veterans Administration does. Healthcare manufacturers routinely say they want a free market, but in practice, they try to create a price-gouging monopoly. In this sense they're no worse than companies in other industries. It's just that the stakes in healthcare are often life and death.

Thanks for your continued support...

We recently asked you to support our journalism. The response, in a word, is heartening. You have encouraged us in our mission — to provide quality news and watchdog journalism. Some of you have even followed through with subscriptions, which is especially gratifying. Our role as an independent, fact-based news organization has never been clearer. And our promise to you is that we will always strive to provide indispensable journalism to our community. Subscriptions are available for home delivery of the print edition and for a digital replica viewable on your mobile device or computer. Subscriptions start as low as 25¢ per day.We're thankful for your support in every way.